Medical Questions > Conditions and Diseases > Broken Bones Forum

Bad Accident Resulting in Tibia & Fibula Break =(

May 25th 2013, I was in a really bad quad accident. I hit a corner on some really dry loose gravel; losing control of my quad. I flew off a step embankment, hit a tree, and was throw down into a creek. I knew something was broken; badly! The pain was horrific, and getting me out of the creek and back up to the road will be something that forever haunts me!
I was then rushed by ambulance to the hospital where they found a broken tibia, and fibula. Because of swelling, the surgery was done the following morning. The surgeon told me that he had put in a nail with two screws by my knee, and two screws by my ankle.
I was able to leave the hospital three days later, but after three days of leaving the hospital, I ended up getting a really bad infection, resulting in another ambulance ride back to the hospital, and readmitted to get the infection under control.
It has now been four weeks since my accident, and my frustration level as at an all-time high! Not only did I use up all my vacation time during this process; my passion is being outside, which includes wakeboarding, tubing, walking, biking, anything to do with enjoying the outdoors is something I can’t do (feeling like a wild animal being caged-up). I had just got my boat “un-winterized.” Bought a brand new wakeboard, and I will not be able to use any of this. The other part is this pain! My knee and ankle have been giving me such grief. I have read people having the “Tibial Nailing” done, often times experience this, but how long should I expect this to give me grief? If I stand up too long, my ankle/foot start to swell, with a throbbing type pain. I’m not sure why I’m dealing with more ankle/knee pain versus pain from the actual break?
With being a single mom having three kids, and trying to do anything has been extremely challenging! I am happy to have a wonderful boyfriend & family; helping me as best as they can with their time schedules. My doctor stated I can’t put any weight for about four months, but I was told after 6 weeks I can drive. Being a month out right now, I can’t even imagine how I could possibly be ready to drive in the next two weeks??? Anxious to start doing more by myself!
Also, on one last note… I am curious as to why the majority of my leg; from the knee down, is partially numb? I touch it, and I can kinda feel the touch, but it’s a light tingly sensation? I’m hoping this isn’t nerve damage from the surgery, and it will eventually come back?
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replied June 24th, 2013
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Not sure why this showed up as "Anonymous" considering I created a new account in order to post. =( Not sure if there is a way to tie my username with this post?
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replied June 24th, 2013
glxpassat,

As to why the post was listed as "Anonymous", that has been occurring occasionally since the website was updated several days ago. It occurs when the session has been "timed out". But, it really isn't a big deal.


Unfortunately, tibial shaft fractures are a significant injury and you are going to have a very long road ahead of you. If you cannot get your "head wrapped around" this, you are really going to have problems. If you think you are becoming clinically depressed, get help for that. Depression will cause you to have significant problems with rehab.


As to driving, that is a very personal activity. There are some quadriplegics who can drive modified vehicles, yet there are other patients who cannot drive with a hangnail. Though your surgeon may say that you can try to drive, it is ultimately up to you to determine if you feel safe behind the wheel. If you would not risk your children being in the car with you driving, then you are not ready to drive. You will know when you are ready to drive. When you feel it is time to try, you should have a friend/family member take you out to a deserted parking lot or out in the country where you can practice starting, stopping, parking, etc. Also, be aware that research studies have found that patients with lower extremity injury/surgery have reduced braking times, for up to as much as a year after the injury/surgery. Be sure to allow extra distance between you and the vehicle in front of you for increased braking response times. Again, you will know when you are ready to drive.

Also, you have to be really careful about driving if you are nonweight bearing. If you are in an accident, even if it is not your fault, if the police officer sees that you are using crutches, you may be cited for driving while "impaired". Not saying it is correct, just a reality. Also, if you are still taking opioid pain medication, you have to be very careful.



As to healing times for tibia fractures, it can take as much as 20 weeks for a tibia to unite after a high energy fracture (a quad accident is high energy). And that is just for union of the bone, that does not include rehab time at all.


About weight bearing status in tibia fractures, that depends greatly on the fracture pattern. Transverse fractures can have weight bearing on them immediately after the nail is placed. But, long obliques/spiral fractures are inherently unstable, and usually the surgeon will want to see some callus formation before allowing a lot of weight bearing.


But, you can still work on ankle and knee motion, even though you are not doing a lot of weight bearing. If your surgical wounds are now clean and healed, you might look into getting into a swimming pool for water exercises. The warmth of the water makes the tissues more pliable. The buoyancy of the water, in chest deep water, makes exercises essentially nonweight bearing. And, exercising in water is very safe, as you cannot "fall down" in water.


As to the swelling, when you injured your leg, you did not just damage the bone. All of the soft tissues around the fracture site where also injured. This includes the veins and lymphatics. So, you are going to have some problems with edema when the leg is in a dependent position (hanging down). Venous blood, lymphatic fluid, and edema all have to be pumped back to the body's core. This is done by muscle action, the contraction and relaxation of the muscles in the calf and thigh. Also, gravity will help to move the fluids back to the body, so elevating the foot above the heart level will is a must.

You can also help the swelling with thigh high compression hose. You might want to get some TED hose (used in hospitals). The circumferiential compression applied by these hose will help to push the fluids out of the tissues and into the veins and lymphatic channels. And, again, many of the veins and lymphatic channels need to reconstitute (regrow). That is going to take time.


The numbness over the leg could be temporary or permanent. Only time will tell. If you do not have any numbness/tingling distally in the foot, then the probably is probably confined to the skin nerves of the leg. Again, when the injury occurred, there was some shearing of the skin and subQ tissues. This can affect the feeling over a large area of the leg. You may also note an area of dense numbness just below and to the lateral side of the incision at the knee. If you have this “hand sized” area of numbness, that is probably permanent. There is a tiny nerve (infrapatellar branch of the saphoneous nerve) when runs just below the patella (kneecap), right across where the incision is made. This nerve is often transected when the incision is made. It is too small to be seen. So, there is no way to save it. It provides the sensation to that area below and to the outside of the incision.

But, if you have more generalized decreased sensation over the leg, that can be from the shearing of tissue or due to the swelling in the leg. This decrease in sensation is usually temporary.


So, again, you have a pretty significant injury, especially since you have developed an infection. Hopefully, the infection was confined to the superficial soft tissues and did not get down to the bone and IM nail. Bone infection (osteomyelitis) is still a big problem, even with modern medicines (antibiotics).


You are going to have a long, long road ahead of you. There is not really a lot of ways to speed up healing, though it can be slowed down. Do Not Smoke. Nicotine is probably the single most detrimental thing there is to fracture healing.

Eat a proper diet, with extra protein, calcium, vitamin D, and magnesium. If you are having problems eating, get your protein with things like Ensure milkshakes. This is not really a time to be on any crazy diets. If your wounds are not completely healed, and they seem to be draining a clear yellow liquid, that is serum (plasma). The liquid portion of blood. When patients are in catabolic states (breaking down tissues to supply the energy needed), their serum albumin (protein) levels are low. This allows “leaking” of serum from the wounds. Usually, an Ensure milkshake twice a day will stop the draining. If your wounds are healed and clean, great, keep them that way.

When your surgeon allows you to start weight bearing, do so. By applying stress across the fracture, it may help to stimulate the body to heal the fracture better. This is known as Wolff’s Law - bone will respond to the stresses applied to it. Currently your tibial nail is statically locked (interlocking screws at both ends). This is a load sparing construct (or load shielding): the nail is taking the majority of the stress. If it looks like your fracture is not healing well, your surgeon may elect to dynamize your nail. This is done by removing the screws at one end and having the patient weight bear. This compresses the fracture and employs Wolff’s Law. The construct then becomes a load sharing construct. More of the stress is taken up by the bone (rather than the nail). This would be the first thing tried to get the bone to heal. But, hopefully, your fracture will heal without too many problems.


But, getting the bone to unite is just the first step. Then you have to do rehab, to get your range of motion and strength back. You should already be working on ankle, knee, and hip range of motion. If you can have full range of motion back, when you start to rebuild your muscles, that will help tremendously.

Also, recovery does not “just happen”. It takes a lot of hard work in the gym and a lot of time. It is not uncommon for recovery from a tibia fracture to take as much as a year to 18 months (if not more). The harder you work at therapy, the more you will get out of it. But, again, it is not just going to happen.

One aspect of rehab that many patients forget to work on is balance and agility. Again, it has to be specifically worked on. Once you get your range of motion and the majority of your strength back, you need to work on balance, agility, and proprioception. The use of a BAPS board or a wobble board can help with this.

Then, you will have to work on any sport specific skills that your usual activities may require.



So, being just one month into your “ordeal” it is a little early to be too discouraged. You have just barely begun on your recovery road. You are going to have good days and you are going to have bad days. As time goes by, the good days should start to outnumber the bad days. You will have ups and downs. You will hit plateaus, where things just don’t seem to be getting any better. This is when you will have to reach down deep and find the necessary guts to keep going on.


Wishing you the best. Good luck.
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replied June 24th, 2013
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As you can see, my response was also listed as anonymous. This is probably because I took too much time and the session was "timed out" before I posted it.

This seems to be a "glitch" with the new website update.

Good luck.
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replied June 24th, 2013
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I REALLY APPRECIATE ALL YOUR INFORMATION FOR STARTERS! I came across this site the past weekend, out of complete boredom, lying in bed with my foot being propped up trying to reduce swelling. Not only was I amazed at all the quick replies with other forum user’s, but your in-depth replies and knowledge around them.

I know it’s only been a month, and a bad attitude is not good for the healing process. I guess I’m still overwhelmed by everything. Discouraged by what my summer has turned into. Summers are my time to do all the activities that I love doing. The sun is like a de-stressor for me I’m trying to keep a positive attitude, but man, it can be hard at times.

I’ve been going to physical therapy for a couple of weeks now; working my ankle and knee for the most part. I’ve been very good at doing all exercises recommended, and I’ll do whatever they say, if it helps with the healing process! Wink Also, I’m glad to hear that swimming is an ok regiment! I had been wondering if I could swim, but didn’t want to do something that could affect the healing process. I was just going to wait until my next doctor’s appointment to ask, but this is good news.

I’m not scheduled to see my doctor for several more weeks; which is when they will do an x-ray, I’m assuming for progress? After my second hospital stay, I saw my doctor, and a week from that appointment I saw him again, as he wanted to keep an eye out on the infection. The incision on the knee was were the infection was. The area was pretty large; ending up blistering. The blistered skin ended up turning into a leather-like blackened appearance. It has since peeled off, and is very pink!

I can certainly see why people would jump back to driving. It’s hard relying on people taking you to and from, but honestly I can’t imagine it being safe for me to return back to driving if I can’t even put weight on my right leg? But who knows what two weeks out will hold for me, as far as my capabilities??

FYI, I have been wearing the “TED sock” since the hospital. The Doc stated I could take it off a week ago, but my leg still swells, and from what I read “NOT” to take off if your leg swells! I understand the purpose of the compression sock, so I honestly don’t want to get a blood clot because I didn’t want to wear. I feel more comfortable when I’m wearing it, then when it’s off. I tend to feel more painful standing if it’s off.

I had been smoking before-hand, but have not smoked (well I had one) since the accident, and as mentioned, I will do whatever it takes to heal as quickly as possible. During all this, I have lost a lot of weight; which is a bummer because I am a thin person to begin with, and the weight loss is pretty shocking. My right (injured leg) leg looks the worse the muscle has completely been lost… I’m not sure how I could have lost sooooo much muscle in a months’ time, but it has! Now that you mentioned getting extra nutrition by grabbing some Ensure milkshakes is perfect, so this will be one of my grocery store purchases tonight! Also per my doctors request I have been taking Vitamin D. I haven’t had any calcium, but I will also be picking some up tonight.

Again thanks for all the info, and I’m sure I will have lots more as-well as my status!!!! =) =)
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replied June 25th, 2013
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glxpassat,

No problem, just hang in there. Yes, it is the pits to not be able to do the things you love. But, this too will pass. Just think, you could be lying in traction for a couple of months, followed by a long leg cast (treatment of tibial shaft fracutures, before the IM nail). That would be the worst.


It is amazing the way the skin heals up so nicely, after the escar sloughs off. You would be amazed, the way wounds heal, when placed under a plaster cast. We rely so much an antibiotics now days, we forget that they have only been around since WWII. A bit of military medical history: during WWII, many soldiers with open fractures were placed in plaster casts and then transferred back to the states. But, they were brought back on ships, which took weeks. By the time these patients got back to Walter Reed, their casts stunk!! But, when the cast was removed, what the surgeons found was healed wounds, with nice pink skin. So, plaster cast treatment of wounds was actually adopted, and it works. Again, nowadays, most patients would be worried that their cast smelled. But, it works. The plaster has this property where it absorbs the fluids and wicks the moisture away from the skin. So, the cast turns brown and smells, but the wound heals.


Again, hang in there. You will get over this.

Good luck.
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replied July 10th, 2013
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Hi Gaelic, its been six weeks now, and I'm seeing days where I'm not experiencing the pain like before. But I have days like today where my knee pain is out of control (had the nail) it seems from what I read its a very common thing. The problem is I've used up all my vacation, and sick days up. So when I can't go to work I'm not getting paid. From your experience when does the knee pain (and ankle) start getting better? I'm scheduled next week to see my doctor. I will get x-rayed, and hoping the go ahead to put some weight on my leg. Any insight would be much appreciated!
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replied July 10th, 2013
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Hi Gaelic, its been six weeks now, and I'm seeing days where I'm not experiencing the pain like before. But I have days like today where my knee pain is out of control (had the nail) it seems from what I read its a very common thing. The problem is I've used up all my vacation, and sick days up. So when I can't go to work I'm not getting paid. From your experience when does the knee pain (and ankle) start getting better? I'm scheduled next week to see my doctor. I will get x-rayed, and hoping the go ahead to put some weight on my leg. Any insight would be much appreciated!
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replied July 17th, 2013
glxpassat, I had a high-energy break, as well, on my right leg. I am 20 weeks out from my accident and "walking" (haha) unassisted. It will come with time. Don't be surprised if the x-ray is not what you hope. Feel free to check out my x-ray pictures... I posted them in a link in this topic:

http://ehealthforum.com/health/very-messed -up-comminuted-distal-tib-fib-t404563.html
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replied July 17th, 2013
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MarilynJane - Wow, you have an amazing break, and now I'm thinking I only had 3 incisions, versus the ones you have! What happened?

I just got back from my doctor’s appointment, and I still have a significant breaks, but I can see cloudiness of sort, where I was told the bones is filling in! Which, I am super happy about! I was also told the majority of my leg numbness should not be permanent, as it's got a tingly sensation when touched... I"M SUPER THRILLED to learn it shouldn't be permanent. My swelling is finally gone, but I still have the circulation problems, I’m guessing it to will go away? The best news of all… is I can get rid of my boot, and start putting weight on the leg!

I have been sooo depressed since the accident, but I now finally see a small light shining through at the end of the tunnel. I know I have a long ways to go, but this is certainly what my mental state needed!!!

Here is my updated XRAY =)

http://s183.photobucket.com/user/glxpassat /media/July162013.jpg.html?sort=3&o=0#/use r/glxpassat/media/July162013.jpg.html?sort =3&o=0&_suid=13740943509160713176975903118 8
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replied July 18th, 2013
I got hit on my motorcycle =( My circulation is the worst, too, and is going to be for a long time. My leg still turns red > purple if the compression sock is off and I don't have it elevated.

Your x-ray isn't there anymore (?) but I know what you mean about the cloudiness. For some reason I was under the impression that the gap would shrink, but really it just fades.

Stay positive! It is a bit of a roller-coaster. I have my good days and bad days ("I am SO TIRED OF BEING BROKEN!"), but I always remember that this is a long process and soak up all the sympathy you can! This is the BEST time to fly and go to parks and movies - you always get to skip the line and are given the best seats =) You don't even need to pout or anything.
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replied July 18th, 2013
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Wow, glad you’re ok! I just know from my accident and what others stated, I fared well, only sustaining the injuries I did. I really shouldn't have been alive, so I'm thankful for that!!! I know about the bad circulation... mine isn't as bad anymore, but it swells easily and turns purple. I'm not wearing the compression sock anymore, but I've saved it just in-case. I am elated now, I'm able to start some weight-bearing... can't believe how exciting just the littlest things make me. I know the roller-coaster ride, although I'm starting to see a little more positivity; not such bad pain, and again, giving me the opportunity to have some weight is helping with my depression 100%.
I would love to hear your continued process? I don’t think people understand the complexity of these high-energy breaks, and the extremely painful and long healing process that takes place!!!!???

Opps, I moved image before, here is the link:

http://s183.photobucket.com/user/glxpassat /media/Quad%20Accident%20May%2025th%202013 /July162013.jpg.html?sort=6&o=29#/user/glx passat/media/Quad%20Accident%20May%2025th% 202013/July162013.jpg.html?sort=6&o=29&_su id=1374183327216044049571013911664
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